Individual
DAWN MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPT
Contact information
Practice address
39 N 25TH ST E, SUPERIOR, WI 54880-5269
(763) 689-5385
Mailing address
4302 ROBINSON ST, DULUTH, MN 55804-2114
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1869
MN
225100000X
Physical Therapist
Primary
5635
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15D94MO
BCBS
MN
05
—
41810700
—
WI
01
—
6411503
MEDICA
MN
01
—
HP25224
HEALTH PARTNERS
MN
Enumeration date
09/28/2006
Last updated
07/09/2007
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